synonyms: pubic symphisitis, osteitis pubis, osteitis condensans
Osteitis Pubis ICD-10
Osteitis Pubis ICD-9
- 733.5 Osteitis condensans (piriform sclerosis of ilium)
Osteitis Pubis Etiology / Epidemiology / Natural History
- Typically not infections inflammation of the pubis symphysis
- synonyms: pubic symphysis, symphysis pubis, or symphysis pubica
- May occur after invasive pelvic procedures, pregnancy/childbirth, trauma
- May occur in certain sports: dance, ballet, running, rugby, hockey, tennis, football, soccer.
- Generally occurs in patients 30-50 yrs old.
Osteitis Pubis Anatomy
- May be associated with inflammaiton of the adductor longus
Osteitis Pubis Clinical Evaluation
- Complain of hip, pelvic and groin pain.
- Tenderness of symphysis pubis.
- Increased pain with rectus abdominus testing and bilateral compression of the greater trochanters.
- May have waddling gait.
Osteitis Pubis Xray / Diagnositc Tests
- Plain films of the pelvis may demonstrate sclerosis, lysis and widening of the pubic symphysis
- MRI: inflammatory signal changes in the pubic symphysis +/- bone marrow edema.
Osteitis Pubis Classification / Treatment
- Rest, NSAIDs, directed physical therapy, with gradual return to sports when symptoms subside.
- May require cane/crutches. Consider sacroiliac belt.
- Consider steriod injection into the pubic symphysis (Holt mA, AJSM 1995;5:601)
- Surgical options: (rarely indicated) curettage, arthrodesis, wedge resection.
Osteitis Pubis Associated Injuries / Differential Diagnosis
- Adductor strain
- Hamstring strain
Osteitis Pubis Complications
- Continued pain
- Pelvic instability
Osteitis Pubis Follow-up Care
- Athletes generally should refrain from sports until symptoms completely resolve and they have completed a graduated return to sport exercise program. This often takes 3-6 months.
- Average time to recovery is 7-10 months.
- Recurrence is common
Osteitis Pubis Review References
- Williams PR, AJSM 2000;28:350
- Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. Sep 30 2008
- Mehin R, Meek R, O'Brien P, et al. Surgery for osteitis pubis. Can J Surg. Jun 2006;49(3):170-6.
- Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. Jan 2008;36(1):122-8.
- Andrews SK, Carek PJ. Osteitis pubis: a diagnosis for the family physician. J Am Board Fam Pract. Jul-Aug 1998;11(4):291-5.